Magnetolaser Correction of Microcirculatory Disorders in Complex Treatment of Patients with Diabetic Foot Syndrome

The dissertation is dedicated to the study of microcirculatory disorders in patients with diabetic foot syndrome and the development of a methodology for their correction using magnetolaser therapy. The research includes clinical examination, computer capillaroscopy, laser Doppler flowmetry, and polarography. The author demonstrates the effectiveness of complex treatment involving magnetolaser therapy, which allows improving the morpho-functional parameters of the microvascular bed and shortening wound healing times.

Relevance of the problem

More than 120 million people in the world suffer from diabetes mellitus, and approximately the same number of patients have undiagnosed diabetes. Over the last decade, the life expectancy of such patients has increased due to recent achievements in modern medicine in the treatment of this disease. However, along with this, the frequency of late complications of diabetes, in particular diabetic foot syndrome, has increased (Balabolkin M.I., 1994, 1997; Kalinin A.P. et al., 1993; Jettcoat W. et al., 1995; G.Pogano et al., 1994; Young M.J. et al., 1993).

Diabetic foot syndrome is a pathological condition of the foot in diabetes mellitus, characterized by damage to the skin and soft tissues, bones and joints and manifesting in the form of trophic ulcers, skin-joint changes and purulent-necrotic processes (Dedov I.I. 1998).

The pathogenesis of diabetic foot syndrome development is based on diabetic neuropathy, micro- and macroangiopathy and impairment of peripheral microcirculation (Duvansky V.A. et al., 2002, 2004, 2005; Krivikhin D.V., 2006). The features of the course of the wound process in patients with diabetes mellitus are due to the aforementioned symptom-complex of anatomo-functional changes (A.P. Kalinin, 1993). They manifest in the delay of granulation tissue formation and skin epithelization, elongation of the inflammation and regeneration phases, suppression of fibroblast proliferation and decrease in the synthesis of RNA, DNA, glycoproteins and collagen (Sopromadze M.A., 1995; Lebedkov E.V., 2000: Tolstyh P.I. et al. 1998, 2002).

To solve this problem, a large arsenal of diverse means is proposed, in particular high-energy and low-energy lasers (Lebedkov E.V., 2000; Tolstyh P.I., 2000, 2001; Kalinin M.R., 1997, 2001, 2005; Duvansky V.A., 2003, 2004: Mikhailov V.G., 2005; Tolstyh M.P. et al., 2006).

In a number of recent works, the effectiveness of the use of intravenous laser blood irradiation (ILBI) and NILT in the treatment of purulent-necrotic forms of diabetic foot syndrome has been proven (Dochenko N.M. 1998; Telianidi A.G., 1999; Lebedkov E.V., 2000: Tolstyh P.I. et al., 1998, 2002; Lutsевич O.E. et al., 2006). There are few reports in the literature on the use of magnetolaser therapy in the treatment of surgical patients (Briskin B.S. et al., 1990, 1992, 1999; Polonsky A.K. et al., 1993; Rodionov I.E., 2001). The questions of the use of magnetolaser therapy in the treatment of patients with purulent-necrotic forms of diabetic foot syndrome are devoted to isolated works (Briskin B.S. et al., 1999). A.K. Polonsky et al. (1984) experimentally showed that the combination of IMP (25-30 mTl) and LT (4.5-5.0 mW/cm²) is more effective than laser therapy and magnetotherapy used separately. The combination of these two methods is not an ordinary sum of effects, but has a character of synergistic-resonant effect, which has a more pronounced effect on the organism. (Kozlov V.I., Builin V.A., 1995: Moskvin S.V. Builin V.A., 2006).

At the same time, there are no reports in the literature on the use of magnetolaser therapy in the correction of microcirculatory disorders in complex treatment of patients with diabetic foot syndrome. This determined the relevance of the present research.

Goal of the research

To study the clinical-morphological features of microcirculation in patients with diabetic foot syndrome and to evaluate the effectiveness of magnetolaser correction of microcirculatory disorders in this category of patients.

Tasks of the research

1. To conduct a comprehensive study of the state of microcirculation in patients with diabetic foot syndrome using clinical, morphological, and functional research methods.

2. To evaluate using computer capillaroscopy the dynamics of changes in microcirculation indicators in patients with diabetic foot syndrome during complex treatment with the use of MILT.

3. To study using laser Doppler flowmetry and polarography the features of regional microcirculation in patients with diabetic foot syndrome and to evaluate the influence of magnetolaser therapy on indicators of regional microcirculation.

4. To develop, implement in clinical practice, and give a comparative evaluation of the methodology of complex treatment of patients with diabetic foot syndrome using magnetolaser therapy.

Scientific novelty

For the first time, a clinical-morphological characterization of microcirculatory disorders in diabetic foot syndrome is given, which consist in a change in morpho-functional parameters of the microcirculation system.

A new pathogenetically justified methodology of complex treatment of patients with diabetic foot syndrome using magnetolaser therapy has been developed, which allows significantly improving the results of treatment of this category of patients, shortening the healing time of wounds.

For the first time, a comprehensive comparative study of the influence of magnetolaser therapy on the state of the microcirculatory bed in patients with diabetic foot syndrome has been conducted, and it has been proven that the use of magnetolaser therapy in complex treatment allows achieving more stable morpho-functional changes in the microvascular bed.

Practical significance of the research

A methodology of magnetolaser correction of microcirculatory disorders in patients with neuropathic and mixed forms of diabetic foot syndrome has been developed. Indications and contraindications for its use have been determined. This methodology allows improving the neuroregulation of the microvascular bed, as well as the morphology of capillaries, which prevents the development of trophic disorders of the foot and shortens the treatment time.

Validation of the work

The main provisions of the dissertation were reported and discussed at the international scientific-practical conference «Laser technologies in medical science and practical healthcare» (Moscow, 2004) and at the international symposium «Diabetic Foot» (Moscow, 2005).

Implementation in practice

The developed methodology of complex treatment of patients with diabetic foot syndrome using magnetolaser therapy has been implemented and is used in the city polyclinic No. 139 of Moscow, at the Department of Laser Medicine of the FPK MP RUDN.

Publications

6 scientific works have been published on the topic of the dissertation.

Structure and volume of the dissertation

The dissertation is presented on 135 pages of typed text and consists of an introduction and chapters: materials and research methods, results of examination and treatment of patients with diabetic foot syndrome, conclusions, provisions, practical recommendations and reference list, including works by domestic and 64 foreign authors. The work is illustrated with 17 tables and 20 figures.